Successful treatment of pyogenic spondylitis in a non-ankylosing lesion of diffuse idiopathic skeletal hyperostosis using penetrating endplate screws: a three-case report

Both pyogenic spondylitis and diffuse idiopathic skeletal hyperostosis (DISH) can develop in the thoracolumbar spine of older adults. Among patients with pyogenic spondylitis, those with DISH reportedly have a significantly higher mortality rate than those without DISH. However, the reasons for this increased mortality and effective strategies for preventing fatal outcomes remain to be determined. Here, we report three cases of pyogenic spondylitis affecting non-ankylotic lesions in older patients with DISH. These patients were successfully treated with anterior and posterior fixation using penetrating endplate screws, which provide strong fixation and are particularly advantageous in DISH. In cases of pyogenic spondylitis involving non-ankylotic lesions in DISH, early spinal fixation with penetrating endplate screws, guided using computed tomography and magnetic resonance imaging, may help prevent older adult patients from becoming bedridden.